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Cervical Spondylosis

What is cervical spondylosis?

The term cervical relates to the neck and the term spondylosis relates to the changes that occur in your spinal joints, discs and other tissues as you get older.

In simple terms, it is best to consider spondylosis the aging process of your spine. If you look in the mirror, you may find that you do not look like you did when you were 18 years old. You may have a few more wrinkles and a few more grey hairs than back then and these are generally accepted by most people as the outward signs of aging. Your joints and discs within your spine undergo the same aging process and you are exactly the same age on the inside as you are on the outside. therefore, it isn’t realistic to expect your spine to look like it did when you were 18 either! Perhaps thinking about spondylosis as the grey hair and wrinkles of your spine may help you understand it better.

Why have I heard it described as ‘wear and tear’?

As with many other things, sometimes when certain words or phrases are used to describe something, they stick. Unfortunately, the term ‘wear and tear’ is used very regularly to describe neck issues and it is not really helpful. Nothing in your neck is ‘worn’ or ‘torn’, therefore the phrase can be misleading as it suggests that the issue you may have with your neck is due to damage.

Does it really matter what you call it?

We really think it does. Words are incredibly important as they help us understand what might be going on in our neck and what we are dealing with. If you have been told that you have neck pain and that it's something you need to be concerned about, then it is only human to find yourself worrying about it. If things are explained correctly and words, phrases and images are used appropriately, you are likely to understand the issue better and be in a better frame of mind to do something about it.

Interestingly, a study by Kim et al. (2017) found that emotional stresses and challenges, such as low mood and worry, appeared to be more likely to contribute to neck pain than physical factors. In other words, how you feel and what you think about your neck issue does matter!

So, my neck isn’t damaged?

Cervical spondylosis isn’t damage and therefore, using the word damage to describe it is not accurate. Spondylosis describes the adaptive and useful changes in the way your joints/discs look and work in order for them to cope with the fact that they’re getting older (not 18 years old anymore!)

What are the common symptoms of cervical spondylosis?

This is a really important question and it is useful for you to know what is normal for a neck that may have spondylosis. We’ve broken the answer down into things that are found most commonly:

How is cervical spondylosis diagnosed?

In most cases, cervical spondylosis can be suspected or diagnosed through the clinical features (what it looks like and how it behaves), your symptoms (what you tell us about your neck) and the clinical assessment (testing the movements etc.). An X-ray of the neck can be used to help diagnose spondylosis but is not always required. 

Why are X-rays/scans not always required?

In a lot of cases, the information we as healthcare professionals can get from asking you questions and testing the neck is enough to make a decision. X-rays are a very useful tool as they show you what your neck looks like on the inside, however in some cases what your neck looks like on the inside doesn’t really marry up with what your problem might be.

There is growing evidence (experiments and clinical studies) that demonstrate what you see is not always what you get with X-rays and scans, and that a lot of the so-called ‘worn out’ or ‘abnormal’ findings are seen commonly in people with no pain, stiffness or symptoms.

In a large study of over 1200 people, Nakashima et al. (2015) demonstrated that most of the common ‘problems’ found in neck scans, including disk changes, are seen as much and sometimes more, in people WITHOUT any pain, stiffness or symptoms as those with symptoms.

What this means is that what you say about your neck issue, how you move and how you feel etc. are often more important than the results of an X-ray or scan.

What causes cervical spondylosis?

This is a difficult question and the simplest answer is that it is complicated. As we’ve explained in the last question, what you see is not always what you get and that just because an X-ray says you’ve got spondylosis of the neck doesn’t mean you’ll actually have any problems.

There are many factors that will influence the development of symptoms, including (but not limited to) work role, low activity levels, previous injury, diet, genetics, how you feel about your neck and negative beliefs. It is unlikely that just one of these factors will cause you to have any symptoms, however, it may be that they may each have a subtle influence and something (sprain or strain, bad day at work or stress) may act as a trigger for the symptoms to then develop.

What can I do to help myself?

Reassuringly, there are lots of things that you can do to help get your neck going and start your rehabilitation.

What can physiotherapy do for me?

Physiotherapy for neck complaints including spondylosis can be very effective. We offer a range of options to help you manage your complaint with exercise, education and lifestyle advice/ coaching forming the main part of what we can offer you. We are able to offer other treatments including manual therapy and acupuncture if deemed appropriate, however these would only likely be offered alongside the exercise, education and lifestyle advice.


Is there anything I should look out for?

In most cases, neck symptoms associated with spondylosis are easily recognised, but occasionally there are things that do not fit and should be highlighted to your doctor, nurse or physio:

  • Generally feeling unwell and/or a temperature alongside your neck pain
  • A history of trauma that started your neck pain
  • Pain or symptoms that travel into your face
  • Headaches that are different to your normal headaches
  • Changes in your vision, speech or hearing alongside your neck pain
  • Difficulty coordinating your arms or legs
  • Pins and needles or numbness in your both your arms, or both your legs or all limbs

Will it get better?

In a lot of cases, it is very much possible for you to improve the symptoms you have with your neck. Obviously, you cannot turn back the clock and the spondylosis will still be there even if you feel better, but by being stronger, fitter, more confident and closer to your ideal bodyweight, you can start to regain some more control over your neck.

Encouragingly, in a large review of the research on neck pain sufferers, de Zoete et al. (2019) found that exercise (of any type) helped to lower pain levels and improve disability.


How long will it take before I feel something?

This is a very difficult question, but it is best to think about how much time and effort you are going to throw at the challenge and how confident and motivated you are to do something about it. If you work hard and are consistent with what you do, often people will notice signs of positive response within weeks to months. If you are not committed to the challenge, it will take longer or may not respond at all.

Frequently asked questions

Below are some of the common questions that are asked when talking about neck issues that haven’t been covered in the information above:

A: Collars and supports for neck pain are no longer recommended. It used to be that collars were issued by physios for neck issues, however, we now understand that these can actually make things worse, as keeping your neck still will not support normal movement, will cause strength loss and may make you feel worried about moving your neck when the support comes off.

A: Acupuncture is something that can help some people, however not everyone benefits from it. Acupuncture is best thought of as a type of pain relief and as such, it might help ease the pain temporarily but will probably do very little to address the reason why your neck is sore in the first place. Working on normal confident movement and the strength of your neck is likely to help most people.

A: Interestingly, this is not as clear as some people might have you believe. In a study by Gamkhar & Kahlaee (2018), no significant link between head and neck posture in pain could be found in people with and without neck pain, however muscle size was significantly smaller in people with neck pain. In other words, it doesn’t really matter what your posture is like but things like your strength, fitness and confidence in your neck and how well you manage things like stress seem to matter.

A: This doesn’t matter. Most, if not all, of the exercises below can be modified or adapted using heavy bags, bottles of water or even books.

A: If your neck is sore to begin with, then it is normal to expect that starting some exercises might be a bit sore to start with. As you get better and start to tolerate the exercises better, you should find that they are more comfortable. However, it is worth knowing that strengthening exercises are meant to be hard work (and a bit sore), so if they’ve become too easy perhaps you need to increase the challenge.

A: The pain in your neck is not an indication of damage, therefore it is safe to move your neck normally. If something is really sore, it makes sense not to force it and work within a range that is comfortable, but it is safe to be sore.

A: Quite simply, no! The exercises will help get you moving and hopefully help with your strength, which are both important for helping neck pain. However, often looking at the things that your neck doesn’t like, such as sitting for long periods/carrying shopping and making some changes/adaptations to those things will help the exercises be more effective.

A: If you are not having issues with your sleep then changing your pillow isn’t likely to help. If you are having issues, first think about what changes/effort you're putting into controlling your neck during the day as this is likely to be most effective. If you want to change your pillow and think it will help, then choose the one that is most comfortable. There isn’t a ‘best’ pillow as we all have different needs and preferences.

A: Firstly, ask yourself if you have really done everything you can to try and move your neck issue forwards. If the answer is no, consider re-reading the information above and seeking some guidance from your physio.

If you have really committed to your rehabilitation and still don’t find any benefit, then please bring this up with your physio who will be able to discuss your options.

Exercise tips:

For movement exercises, aim to complete the exercises little and often throughout the day within what is comfortable.

For strengthening, you may choose to start by simply completing the exercises until your neck gets tired for 3-4 sets with about a minute’s rest in between sets. If you want more structure, try completing 8-12 repetitions for 3-4 sets with about a minute’s rest in between sets. Complete these exercises every other day.

Bricca A., Roos E,M.,  Juhl C,B., Skou S,T., Silva D,O., Christian J. and Barton C, J. (2019). Infographic. Therapeutic exercise relieves pain and does not harm knee cartilage nor trigger inflammation. British Journal of Sports Medicine. DOI: 10.1136/bjsports-2019-100727 (accessed 26/01/2021).

de Zoete R, M, J. ,  Armfield N, R.,  McAuley J, H., Chen, K. and  Sterling, M. (2019). Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. European Journal of Physiotherapy (accessed 26/01/2021).

Gamkhar, L. and Kahlaee. (2018). Is forward head posture relevant to cervical muscles and performance and neck pain? A case-control study. Brazilian Journal of Physical Therapy, 23(4) 346-354 doi: 10.1016/j.bjpt.2018.08.007. Epub 2018 Aug 22 (accessed 29/01/2021).

 Kim, R., Wiest, C., Clark, K. and Cook, C.   (2017). Identifying risk factors for first-episode neck pain: A systematic review. Musculoskeletal Science and Practice, Volume 33, 77-83 (accessed 26/01/2021).

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